Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
ASQ Intake Questionnaire (Chinese, Korean, Vietnamese - Subset) New 116 2 0 Form and Instruction NA ASQ Intake Questionnaire (Chinese - Subset)
Form and Instruction NA ASQ Intake Questionnaire (Korean - Subset)
Form and Instruction NA ASQ Intake Questionnaire (Vietnamese - Subset)
Asian Smokers Quitline (ASQ) Intake Questionnaire (Complete Chinese, Korean, Vietnamese) New 803 134 0 Form and Instruction NA NQDW Intake Questionnaire - Chinese Complete
Form and Instruction NA NQDW Intake Questionnaire - Korean Complete
Form and Instruction NA NQDW Intake Questionnaire - Vietnamese Complete
Asian Smokers Quitline (ASQ) Seven-Month Follow-Up Questionnaire New 659 77 0 Form and Instruction NA NQDW 7-Month Follow-Up Questionnaire - English
Form and Instruction NA NQDW 7-Month Follow-Up Questionnaire - Chinese
Form and Instruction NA NQDW 7-Month Follow-Up Questionnaire - Korean
Form and Instruction NA NQDW 7-Month Follow-Up Questionnaire - Vietnamese
Follow-up for Callers who Received a Quitline Service Removed 0 0 0 Form and Instruction F1 NQDW 7-Month Follow-Up Questionnaire
NQDW Intake Questionnaire (English complete) - Callers who contact Quitline for themselves Modified 478638 79773 0 Form and Instruction NA NQDW Intake Questionnaire - Complete
NQDW Intake Questionnaire (English subset) - Callers who contact Quitline on behalf of someone else Modified 26007 434 0 Form and Instruction NA NQDW Intake Questionnaire - Subset
NQDW Quitline Services Survey Modified 216 72 0 Form and Instruction NA National Quitline Data Warehouse (NQDW) Quitline Services Survey
Submission of NQDW ASQ Seven-Month Follow-Up Electronic Data File to CDC New 1 1 0 Instruction
Submission of NQDW Intake Questionnaire Electronic Data File to CDC Modified 216 216 0 Instruction
Total burden requested under this ICR: 506656 80709 0  
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